Digital Commons Network^™

Contextual Factors Influencing The Acute Care Registered Nurse's Response To Clinical Alarms, Kathleen M. Stacy

Dissertations

Nurses are faced with a multitude of clinical alarms on a daily basis. There is an inherent expectation that upon hearing an alarm the nurse will immediately respond to assess the situation and initiate appropriate action to correct the problem. Yet this does not always occur. Issues with alarm responsiveness can pose a serious threat to patient safety. The purpose of this qualitative study was to develop a broader understanding of the contextual factors that influenced the acute care nurse's response to clinical alarms. This study used an interpretive phenomenological methodology to study the lived experiences of the nurses who …

Medication Adherence To Successful Tuberculosis Treatment Outcome Among Tb/Hiv Patient At Prof. Dr. Sulianti Saroso Infectious Disease Hospital, Yusmaniar Yusmaniar, Adin H Kurniawan

Pharmacology and Clinical Pharmacy Research

Tuberculosis/Human Immunodeficiency Virus (TB/HIV) co-infection has poorer treatment outcome compared to non-co-infected patients. To benefit from therapy and to avoid contracting treatment-resistant strains, the individuals must adherent to medications. There is limited information regarding successful TB treatment outcomes and their associated factors. Thus, the study was designed to identify medication adherence associated with treatment outcomes among TB/HIV Patients at Prof. Dr. Sulianti Saroso Infectious Disease Hospital. This research was an observational study with retrospective approach from January 2015 to December 2017 by taking data from medical records and TB-01 form of TB/HIV patients in the outpatient clinic of the disease …

Maternal Prenatal Cortisol Programs The Infant Hypothalamic–Pituitary–Adrenal Axis, Jessica L. Irwin, Amy L. Meyering, Gage Peterson, Laura M. Glynn, Curt A. Sandman, Laurel M. Hicks, Elysia Poggi Davis

Psychology Faculty Articles and Research

One of the key proposed agents of fetal programming is exposure to maternal glucocorticoids. Experimental animal studies provide evidence that prenatal exposure to elevated maternal glucocorticoids has consequences for hypothalamic–pituitary–adrenal (HPA) axis functioning in the offspring. There are very few direct tests of maternal glucocorticoids, such as cortisol, during human pregnancy and associations with infant cortisol reactivity. The current study examined the link between maternal prenatal cortisol trajectories and infant cortisol reactivity to the pain of inoculation in a sample of 152 mother-infant (47.4% girls) pairs. The results from the current study provide insight into fetal programming of the infant …

Autoregulation Of Yeast Ribosomal Proteins Discovered By Efficient Search For Feedback Regulation, Basab Roy, David Granas, Fredrick Bragg Jr, Jonathan A Y Cher, Michael A White, Gary D Stormo

Open Access Publications

Post-transcriptional autoregulation of gene expression is common in bacteria but many fewer examples are known in eukaryotes. We used the yeast collection of genes fused to GFP as a rapid screen for examples of feedback regulation in ribosomal proteins by overexpressing a non-regulatable version of a gene and observing the effects on the expression of the GFP-fused version. We tested 95 ribosomal protein genes and found a wide continuum of effects, with 30% showing at least a 3-fold reduction in expression. Two genes, RPS22B and RPL1B, showed over a 10-fold repression. In both cases the cis-regulatory segment resides in the …

Seasonal Variation Of Vertical Heat And Energy Fluxes Due To Dissipating Gravity Waves In The Mesopause Region Over The Andes, Yafang Guo, Alan Z. Liu

Publications

Vertical energy transports due to dissipating gravity waves in the mesopause region (85–100 km) are analyzed using over 400 h of observational data obtained from a narrow-band sodium wind-temperature lidar located at Andes Lidar Observatory (ALO), Cerro Pachón (30.25°S, 70.73°W), Chile. Sensible heat flux is directly estimated using measured temperature and vertical wind; energy flux is estimated from the vertical wavenumber and frequency spectra of temperature perturbations; and enthalpy flux is derived based on its relationship with sensible heat and energy fluxes. Sensible heat flux is mostly downward throughout the region. Enthalpy flux exhibits an annual oscillation with maximum downward …

How Live Streaming And Twitch Have Changed The Gaming Industry, Krystal Ruiz

ART 108: Introduction to Games Studies

Live streaming in itself has become a booming industry in which its content consists of “streamers” who live broadcast numerous events and real-time interactions while simultaneously chatting with viewers drawing huge and increasing numbers (Adamovich). Twitch has especially excelled at garnering attention as one of the most popular live streaming platforms that focuses on broadcasting and viewing video game content (Adamovich). Twitch has grown rapidly within the last few years asserting its dominance as one of the major forces in the games industry and becoming a multi-billion-dollar industry (Adamovich). For example, according to Descrier, in 2016 there were approximately 292 …

An Innovative Contest: A Team Approach To Improving Patient Satisfaction Scores For Medication Side Effects, Jennifer Natsch-Jensen

Master's Projects and Capstones

Problem The Home Healthcare Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey question 14 regarding providers discussing possible side effects is below the organizational goal of 74.1 linear mean in this home health microsystem.

Context According to the Agency for Healthcare Research and Quality (AHRQ), nearly 20% of patients discharged home from the hospital had an adverse event within the first few weeks of discharge and most are related to medications (AHRQ, 2019).

Interventions An innovative contest was introduced to promote engagement and to use teach-back best practices, including planned discussions with the patient and caregivers regarding name of …

2020-12-11 Minutes Of The Executive Committee Of The Academic Senate, University Of Dayton. Academic Senate. Executive Committee

ECAS Minutes

Approved minutes of a meeting of the Executive Committee of the Academic Senate of the University of Dayton.

Challenges Of Electrifying Medium And Heavy Duty Vehicles In California And How These Challenges Can Be Overcome, Tracy Tilley

Master's Projects and Capstones

California is electrifying medium and heavy vehicles (vehicles weighing over 8,500 pounds) to reduce greenhouse gas emissions and provide environmental justice for disadvantaged communities. These vehicles are used for delivery, construction, refuse collection or long haul trucking. The three main challenges of electrification are infrastructure, policy and funding. To address these challenges, policy analysis was used to review California’s policies already in place for electrification of medium and heavy duty vehicles. Comparative analysis was used to look at policies in other countries and environmental programs for strategies to help electrification efforts.

California faces a lack of infrastructure of medium and …

The Diamond, December 11, 2020, Dordt University

Dordt Diamond

• Front Page: Dordt Ends Semester with 153 Total Recorded Positive COVID-19 Cases; Home to Quarantine: Dordt Students to Spend Last Two Weeks in Isolation; Saving Those Who Served
• News: Marriage Culture at Dordt University; Ed Starkenburg to Retire from Dordt University; Is Theft a Problem at Dordt?; Small Business Saturday a Life Vest to Some; Students on Campus During Online Learning
• Feature: A Fractured Faith; Rain or Snow, Hot or Cold, 712 Nutrition Has the Healthy Treat for You; Married Professors Share Their Story; De Vries' Agricultural Journey; Custom Clips and College Profits; Buker Brought to Dordt
• Art & Entertainment: …

Effects Of Agricultural Intensification Practices On Smallholder Farmers’ Livelihood Outcomes In Kenyan Hotspots Of Climate Change, F. O. Ouya, O. I. Ayuya, M. I. Kariuki

All Peer-Reviewed Publications

Developing countries, Kenya included are mostly affected by food shortage and poverty as a result of high dependence on agriculture constrained by climate variability, declining land sizes and low agricultural technologies. Agricultural intensification is key in solving these problems to ensure increased farm output per unit land area. This study analyzed the role of agricultural intensification on smallholders’ poverty and food security status. The study is based on data collected from a sample of 320 smallholder households from two Sub-counties of Kenya, Makueni and Nyando. Principle Component Analysis (PCA) was first used to group agricultural intensification practices into clusters. The …

Gtap-Power Data Base: Version 10, Maksym Chepeliev

Department of Agricultural Economics Faculty Publications

This paper documents changes introduced to version 10 of the Global Trade Analysis Project (GTAP) Power (GTAP-Power 10) Data Base construction process relative to the GTAP-Power build stream developed in Peters (2016). First, in Peters (2016) output of the electricity and heat generation sector was split into different technologies using electricity generation data only. We use heat and electricity generation volumes to provide a more representative sectoral split and achieve a better concordance with GTAP 10 Data Base sectoral definitions. Second, we introduce data on country and year-specific shares of transmission and distribution costs in electricity price for 80 countries. …

Policy Analysis: Appropriate Opioid Prescribing Practices For Post-Surgical Patients, Joan S. Daversa

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from …

Faculty Affairs Committee Minutes Of The Academic Senate 2020-12-11, University Of Dayton. Faculty Affairs Committee

All Committee Minutes

Approved minutes of a meeting of the Faculty Affairs Committee of the Academic Senate of the University of Dayton.

Stop The Madness! An Examination Of Mental Health Stigma And Proposal To Implement Widespread Efforts For Its Reduction, Karon Donahue

Research Papers

Many people in the United States are affected by mental health conditions. Mental health stigma is a social problem characterized by negative representation in the media, numerous barriers to obtaining treatment, and feelings of shame for those affected by a mental health disorder. While there is evidence of positive outcomes to some anti-stigma campaigns, there has been a failure for these programs to become widespread, covering all parts of American society. This paper has been created to present recommendations for widespread initiatives at the federal and state level. Recommendations for training and sensitivity programs targeting places of employment and schools, …

Standardizing The Bedside Shift Report: Improving Nurse-To-Nurse Communication, Deepi Sahota

Master's Projects and Capstones

PROBLEM: The Community Living Center (CLC) reveals an immense concern on shift-to-shift handoff report. Shift-to-shift report is done in the report room, often times unclear information is given and critical information is not appropriately conveyed.

CONTEXT: The project was implemented on a 50-bed unit at the Veterans Affairs. The improvement project was focused on collaborative partnerships, standardized bedside shift report, and utilization of the SBAR tool. in the prevention of communication errors.

INTERVENTIONS: The SBAR tool was utilized to provide a framework for effective communication between nurses. The CNL facilitated an hour in-service on bedside shift report to nurses …

Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams

Master's Projects and Capstones

Introduction

Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.

Methods

Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.

Results

Results from …

The Role Of Family Dynamics In Receiving Autism And Neurodevelopmental Services: A Needs Assessment, Bianca Kalia

Master's Projects and Capstones

This study aims to document the effects an autism spectrum disorder (ASD), neurodevelopmental disorder (NDD) diagnosis, or other behavior disturbances has on the family unit as a whole. Through this analysis, we can develop measures that are personalized for the child with autism as well as the caregiver and family unit.

Introducing A New 12 Week Education & Simulation Program To Optimize Financial Performance Of Nurse Managers, Melissa Hathcoat

Master's Projects and Capstones

Problem: Several nurse executives (Waxman 2018; Massarweh, 2017; Hunt, 2018) agree that in today's increasingly complex health care environment, the reality of decreasing reimbursements and increasing focus on value-based metrics reflects a crucial knowledge base for nurse managers. Therefore, it is imperative for unit-based nurse leaders to receive education and support to attain and maintain the requisite business competencies to achieve both fiscal and quality targets in their microsystem (McFarlan, 2020). In an integrated managed care delivery system in northern California, no education curriculum exists for nurse managers and assistant nurse managers that addresses gaps in financial knowledge, skills, and …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …

A Systems Approach To Increase The Icu Nursing Workforce During A Pandemic, Jennifer Mendenhall

Master's Projects and Capstones

A Systems Approach to Increase the ICU Nursing Workforce During a Pandemic

Abstract

In early March 2020 an intensive care unit (ICU) patient died of COVID-19 in an integrated healthcare system hospital in Northern California. Data from China and the CDC indicated that more healthcare members would require intensive care and could overwhelm the 21 acute care hospital macrosystem. A microsystem pilot program to upskill peri-anesthesia care unit (PACU) RNs to care for ICU patients was initiated. Concurrently the upskill pilot program was reviewed by macrosystem nursing leadership. Over a three-week period, the program was standardized, disseminated and implemented across …

Safeguarding Surgical Technologists And Reducing Costs Related To Upper Extremity Strain Injuries In The Or, Wilhelmina Hofilena

Master's Projects and Capstones

Abstract

Problem: In the operating room (OR), complex procedures and processes are performed under time pressures, which presents unique challenges regarding ergonomic-related injuries. Handling surgical instrumentation trays with awkward postures is one of the high-risk tasks performed in the OR that can result in upper extremity (UE) strain. A healthcare system-based hospital in Northern California had five reported upper extremity strain injuries by the surgical technologists (STs) in workplace safety (WPS) performance year (PY) 2018-2019. The project aims to decrease UE strain injuries among STs by improving the quality of surgical instrumentation trays and promoting the culture of safety through …

Optimizing Transitions Of Care To Reduce Readmission Rates, Karen Calura Bayan

Master's Projects and Capstones

The timeliness of post-discharge outreach, a component of the Transition of Care (TOC) process, is a critical determinant for readmission. The Health Plan (HP) serves over 260,000 residents of a large San Francisco Bay Area county by working with community partners to provide health care services through its Medi-Cal (MC) and Cal MediConnect (CMC or Medicare-Medicaid Plan) insurance plan.

This project aims to reduce the HP’s readmissions by 1.5% to 7.37% from a baseline of 8.87% for CMC members and to 6.8% from a baseline of 8.3% for MC members within one year from the onset of the improved TOC …

Creating A Culture Of Teamwork And Communication, Ikjae Yang

Master's Projects and Capstones

This paper aims to explain an innovative strategy for integrating research processes and quality improvement in a medical/ surgical telemetry unit (2 North). The project is targeted to improve health care team communication regarding patient safety to improve patient outcomes. The PICO question guiding this project stated: Does the implementation of TeamSTEPPS during orientation improve communication and teamwork? CINAHL database searched terms "TeamSTEPPS", "new graduate nurses", "communication", "healthcare", "teamwork", and TeamSTEPPS effectiveness. In addition to CINAHL, Google Scholar and PubMed databases were used to narrow down database searches.

The project includes a TeamSTEPPS planning guide that offers the planning organization, …

Financial Literacy For Latino Immigrants: A Guidebook For Esl Teachers, Anna Braden

Master's Projects and Capstones

Latino immigrants face many financial challenges in the United States. Language barriers exclude them from jobs as well as financial and consumer markets. Lack of familiarity with the U.S. financial system or bad experiences with financial systems in their home countries can create mistrust and lead to Latino immigrants being unbanked or underbanked. Consumer vulnerabilities may also be exploited as immigrants turn to nonbank financial services such as predatory lenders (check cashers, payday lenders, etc.). Lack of access to jobs and marketplaces results in lower income and less wealth accumulation. Over time this results in wealth inequality between Latino immigrants …

Prospectus For Mitigating Loneliness During Quarantine For Older Adults In Long Term Care Facilities, Emily Gines

Master's Projects and Capstones

In 2020 as the COVID-19 pandemic resulted in quarantine safety measures and facility closures, facilities that cared for older adults in particular were hit the hardest. Long term care facilities (LTCFs), specifically those that care for older adults with memory care problems, must find ways to provide high-quality, standard care, despite many regulations and changes. Although infection control is an important aspect of care among this population, we must also consider how we can maintain quality of life and social connection. Loneliness is defined as the subjective feeling of being alone or perceived isolation. It can also relate to the …

That’S Fall She Wrote: Decreasing The Patient Fall Rate On A Medical-Surgical Unit Through An Enhanced Fall Algorithm In The Electronic Medical Record, Lauren A. Fast

Master's Projects and Capstones

All falls, regardless of harm, increase the length of stay for the patient in the hospital (Dunne et al., 2014), and are thus a focus for the Clinical Nurse Leader (CNL) in improving patient outcomes at the microsystem level. This paper will focus on the use of an enhanced fall algorithm (Moskowitz et al., 2020) that combines the use of nursing assessment, medications, laboratory results, and service to assess risk of the patient for falls. This algorithm will be integrated into the electronic medical record (EMR) to aid in clinical decision making and communication between staff and the disciplines. The …

Three Good Things To Extinguish Caregiver Burnout, Justin Haley

Master's Projects and Capstones

Caregiver burnout is a widespread issue in healthcare and institutions should be increasingly concerned about burnout because of the significant impact on quality of patient care, employee health, and financial stability. Many interventions and studies regarding burnout are focused on improving systems issues or removing negative stressors on caregivers. Although such interventions may be necessary to attempt, comprehensive systems-wide changes can be cumbersome and expensive, while removing negative stressors may be an unrealistic goal in a fast-paced, demanding healthcare environment. The Three Good Things method is an evidence-based, effective, simple, low-cost intervention to improve feelings of caregiver burnout in which …

Improving Nurse Competency With Rapid Response Narrator Documentation, Sonam Ghoman

Master's Projects and Capstones

Rapid Response Narrator Documentation tool in Epic electronic health record (EHR) is used for scribing purposes during a rapid response event. The RN’s are the ones that usually scribe during a rapid response team (RRT) event. This new tool is able to make documentation easier and efficient for nurses. The rapid response documentation tool in Epic has been in place for a little less than six years. This tool allows for the replacement of traditional paper scribing. An additional benefit of the rapid response documentation tool is that it allows for the scribing to be in real time and is …

Aiming For Zero: Creating A Culture Of Safety And Improving Cauti Outcomes In The Microsystem, Shiela Escobar

Master's Projects and Capstones

Abstract

Problem: Catheter-associated urinary tract infection (CAUTI) remains the leading cause of hospital-acquired infection (HAI) despite being preventable. CAUTI increases the length of stay, morbidity, mortality, readmissions, and costs. There is also increasing antimicrobial resistance in pathogens causing CAUTI. Thus, reducing HAIs such as CAUTI should be a priority for every institution.

Context: The microsystem for this CAUTI quality improvement project is a 24-bed adult medical-telemetry unit in an acute care teaching hospital with excessive CAUTI. This project aims to improve the unit’s CAUTI standardized infection ratio (SIR) from a baseline of 2.54 to 1.75 by October 2020. A SIR …